The effectiveness of post-partum interventions to prevent urinary incontinence: a systematic review

Sabóia, Dayana Maia; Bezerra, Karine de Castro; Neto, José Ananias Vasconcelos; Bezerra, Leonardo Robson Pinheiro Sobreira; Oriá, Mônica Oliveira Batista; Vasconcelos, Camila Teixeira Moreira

doi:10.1590/0034-7167-2017-0338

Cited by 11 publications

(6 citation statements)

References 28 publications

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“…Both pregnancy‐related and obstetric‐related risk factors are seen as important predictors for UI, FI, and POP. Starting a prevention strategy during pregnancy or directly postpartum is therefore recommended 6‐13 . However, knowledge about which pregnancy‐ and obstetric‐related risk factors should be screened is mostly based on inconsistent evidence.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy‐ and obstetric‐related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta‐analysis

Hage-Fransen¹,

Wiezer²,

Otto

et al. 2020

Acta Obstet Gynecol Scand

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Introduction Risk factors for pelvic floor disorders are often related to pregnancy and delivery. Consistent evidence is needed to develop prevention strategies targeting risk factors. The objective of this study is to identify which pregnancy‐ and/or obstetric‐related risk factors can predict urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life by means of a systematic review and meta‐analysis. Material and methods Systematic review Prospero number: CRD42019131758. Literature searches of PubMed, EMBASE, CINAHL, and Cochrane Library were conducted according to PRISMA guidelines (April 2020). Prospective cohort studies describing more than two pregnancy‐ and/or obstetric‐related risk factors on urinary incontinence, fecal incontinence (including flatal incontinence), or pelvic organ prolapse were eligible. Risk of bias was assessed (using Quality In Prognosis Studies [QUIPS]). Studies with high risk of bias were excluded. Data were extracted and checked for accuracy with the CHARMS checklist. Sub‐groups were used to distinguish between a short‐ and long‐term follow‐up period: <18 months (shortterm) and >18 months (long‐term) postpartum. Odds ratios were calculated from reported prevalence rates. Log odds ratios were calculated using SPSS v.24. Variables were pooled using RevMan5. Results Data were extracted from nineteen studies for urinary incontinence, nine for fecal incontinence, and two for pelvic organ prolapse. Multivariate analysis was not possible because of the heterogeneity of the population and outcome measures. Pooled univariate risk factors for urinary incontinence were: urinary incontinence during pregnancy, instrumental vaginal delivery, episiotomy, tears, and constipation. Pooled univariate risk factors for fecal incontinence were: fecal incontinence during pregnancy, maternal age over 35 years, prenatal body mass index over 30 kg/m2, instrumental vaginal delivery, a spontaneous vaginal delivery, oxytocin augmentation, and when the weight of the newborn was more than 4000 g. Both studies for pelvic organ prolapse had a short‐term follow‐up period and cesarean section was the only risk factor that could be pooled. Conclusions Pregnancy‐ and obstetric‐related risk factors predicting pelvic floor disorders postpartum are multifactorial and differ between pelvic floor disorders. The strongest risk factor for incontinence later in life was incontinence during pregnancy. Better quality research with long‐term follow up is needed on this topic.

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Section: Introductionmentioning

confidence: 99%

Pregnancy‐ and obstetric‐related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta‐analysis

Hage-Fransen¹,

Wiezer²,

Otto

et al. 2020

Acta Obstet Gynecol Scand

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“…Out of 24 full-text reviews included in the methodological quality assessment, 18 four reviews [20][21][22][23] were excluded after assessment. Three of the excluded reviews 20,21,23 scored 4/11 points and were excluded because of the low overall scores. One review 22 scored an acceptable 7/11 points, but item 5 was not addressed and for that reason, the review was excluded.…”

Section: Methodological Quality Assessment Of Included Reviewsmentioning

confidence: 99%

Effectiveness of Exercise Interventions on Pelvic Floor Muscle Function of Pregnant and Postpartum Women: A Systematic Review of Reviews

Ryhtä

Axelin

Hamari

2021

Preprint

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BackgroundDysfunctions related to pelvic floor muscles such as urinary incontinence and pelvic pain are common among pregnant and postpartum women. With properly functioning pelvic floor muscles, it is possible to prevent these dysfunctions. Still, shared understanding about effective exercise interventions is missing. The aim of this review of reviews was to form a summary of the existing evidence about effective exercise interventions on pelvic floor muscle function of pregnant and postpartum women. MethodsNine databases were searched by June 12, 2020. PICO was used to define the eligibility criteria. Population: pregnant or postpartum women, interventions: activity-based interventions aiming to affect the function of pelvic floor muscles, comparators: waiting list or usual care, outcomes: disorders concerning pelvic floors muscles, study design: systematic reviews and meta-analysis. Screening and quality assessment were conducted by two researchers separately. The data were extracted and analyzed narratively. ResultsAltogether 20 systematic reviews reporting findings from 147 original studies were included. The methodological quality of the included reviews was mainly good, overall scores varying from 6/11–11/11. The results showed it may be possible to reduce low-back and pelvic pain as well as the severity of pain with exercise interventions during pregnancy but no association with odds of low back and pelvic pain during the postpartum period were found. With prenatal exercise interventions, it is possible to decrease the risk of urinary incontinence during pregnancy and the postnatal period, but the differences between the control group and the intervention group seem to vanish in the late postnatal period. The results were carefully optimistic within postnatal exercise interventions that decreased pelvic pain, reduction in vaginal bulging and pelvic organ prolapse, but more research is needed. ConclusionsOverall, the level of evidence was low. It seems that with exercise interventions it could be possible to prevent and provide care for the disorders of pelvic floor muscles to some extent. However, more high-quality research is needed to support decision making in the health care systems and to get evidence-based knowledge guiding health professionals working with pregnant and postpartum women.

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“…Berrikuspen sistematiko honetan ikusi da erditze ondorengo zoru pelbikoko muskulaturaren entrenamenduari esker gernu-inkontinentziaren intzidentzia gutxitzen dela eta bertako muskulaturaren indarra handitzen dela. Emaitza hauek bat datoz aurretik egindako ikerketekin (14,25). Era berean, American College of Physicians (ACP) erakundearen (26), Urologiako Europar Elkartearen gida klinikoaren (27) eta Cochranen (28) 2018an publikatutako berrikuspen sistematikoaren arabera, emakumeentzat sortutako tratamendu kontserbadoreen artean, lehen aukerako tratamendu gisa gomendatzen da.…”

Section: Eztabaidaunclassified

“…Horiek horrela, zaila da gai honen inguruko ondorio garbia ateratzea. Antza denez, ariketen errepikapen eta serie gehiago, uzkurketa gehiagorekin eta uzkurketak denboran gehiago mantenduz egiten diren entrenamenduak egokiagoak dira, hau da, entrenamendu intentsiboek emaitza esanguratsuagoak lortzen dituzte (25). Hala ere, berrikuspen sistematiko honetan lortutako emaitzekin ez dugu informazio nahikorik hori baieztatzeko.…”

Section: Interbentzioaunclassified

Erditze ondorengo gernu-inkontinentzia ekidin edo tratatzeko zoru pelbikoko muskulaturaren entrenamenduaren eraginkortasuna: berrikuspen sistematikoa

Agiriano

2019

Osag

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Gernu-inkontinentzia nahi gabeko edozein gernu-ihesek sortutako gaitza da. Batez ere emakumeek pairatzen dute eta zoru pelbikoko muskulaturaren disfuntzioaren ondorioz sortzen da, eragile nagusia erditze baginala izanik. Hiru inkontinentzia mota ezberdintzen dira, baina haurdunaldiarekin erlaziorik handiena duena esfortzuak eragindako gernu-inkontinentzia da. Gernu-inkontinentzia tratatzeko hainbat teknika sortu dira. Teknika horien artean ikertuena “Kegel” ariketak diren arren, desadostasuna dago teknika horren eraginkortasunaren inguruan. Hori dela eta, berrikuspen sistematiko honen xedea erditze ondorengo zoru pelbikoko muskulaturaren entrenamenduak, “Kegel” ariketak alegia, gernu-inkontinentzia ekidin edo tratatzeko duen eraginkortasuna aztertzea izan da. Hori lortzeko Pubmed eta PEDro datu-baseetan bilaketa sistematikoa egin zen barneratze- eta kanporatze-irizpideak kontuan izanda. PEDro eskalaren bitartez ikerketen kalitate metodologikoa balioztatu zen. Oro har, berrikuspenean 9 entsegu kliniko aztertu ziren. Ikerlan guztietan emakumeek zoru pelbikoko muskulaturaren entrenamendua egin zuten interbentzio-taldean, gehienetan zortzi astez, eta ebaluazioa interbentzioaren aurretik eta amaitu ondoren egin zitzaien. Orokorrean, fisioterapeutak gainbegiratutako eskola jasotzeaz gain, emakumeek etxean egin zituzten ariketak ia egunero. Hala ere, uzkurketen mota, serie eta errepikapenei dagokienez, protokoloak desberdinak izan ziren ikerketetan. Ikerlan gehienetan emakumeen % 10ek baino gutxiagok utzi zuten bertan behera tratamendua, erabilitako atxikidura-estrategiei esker. Halaber, errehabilitazioaren ostean, interbentzio-taldeetan gernu-inkontinentzia adierazgarriki gutxitu zen; gainera, emakume batzuen zoru pelbikoko muskulaturaren indar-, erresistentzia- eta uzkurketa-ahalmena ere adierazgarriki hobetu zen. Ondorioz, esan dezakegu zoru pelbikoko muskulaturaren entrenamendua eraginkorra dela gernu-inkontinentzia ekidin edo tratatzeko eta, era berean, bertako muskulatura indartzeko. Hala ere, ezin izan da entrenamenduaren protokolorik egokiena zein den zehaztu.

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The effectiveness of post-partum interventions to prevent urinary incontinence: a systematic review

Abstract: there is evidence that programs of exercise of the pelvic floor musculature performed both in the immediate and late post-partum result in a significant increase in muscle strength and contribute to prevent urinary incontinence.

Cited by 11 publications

References 28 publications

Pregnancy‐ and obstetric‐related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta‐analysis

Pregnancy‐ and obstetric‐related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta‐analysis

Effectiveness of Exercise Interventions on Pelvic Floor Muscle Function of Pregnant and Postpartum Women: A Systematic Review of Reviews

Erditze ondorengo gernu-inkontinentzia ekidin edo tratatzeko zoru pelbikoko muskulaturaren entrenamenduaren eraginkortasuna: berrikuspen sistematikoa

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